Advertisement
American Journal of Kidney Diseases

Association of Smoking Status With Mortality and Hospitalization in Hemodialysis Patients

      Rationale & Objective

      The relationship between tobacco smoking and comorbid condition outcomes in hemodialysis (HD) patients is not well understood. This study examined the association of tobacco smoking status with hospitalization and mortality in HD patients.

      Study Design

      Retrospective cohort study.

      Setting & Participants

      Adult HD patients at 2,223 US dialysis centers with HD vintage of 30 days or less who completed a tobacco smoking status survey as part of standard care between April 2013 and June 2015.

      Predictor

      Tobacco smoking category: never smoked, currently living with smoker, former smoker, moderate smoker (<1 pack per day), or heavy smoker (≥1 pack per day).

      Outcomes

      Death and hospital admissions within 2 years of the tobacco smoking survey.

      Analytical Approach

      Kaplan-Meier analysis and Cox proportional hazards regression for time to death; cumulative incidence function and Cox proportional hazards regression for time to first hospitalization; negative-binomial regression for number of hospitalizations.

      Results

      Of 22,230 patients studied, 13% were active smokers. Mortality probabilities increased with greater exposure to smoking (17%, 22%, 23%, and 27% for never, moderate, former, and heavy smokers, respectively; P < 0.001), as did incidence rates for first hospitalization (23%, 27%, 27%, and 30%, respectively; P < 0.001). Compared to never smoked, heavy smokers had the highest mortality rate (HR for heavy smokers, 1.41 [95% CI, 1.18-1.69]; HR for moderate smokers, 1.39 [95% CI, 1.24-1.55]; HR for former smokers, 1.19 [95% CI, 1.11-1.28]). Living with a smoker was not associated with mortality (HR, 0.93; 95% CI, 0.72-1.22). HRs for first hospitalization followed similar patterns. The incidence rate of mortality for active smokers with diabetes was 173.7/1,000 patient-years and 103.5/1,000 patient-years for those who never smoked (incidence rate ratio, 1.68; P < 0.001).

      Limitations

      Self-reported survey without detailed history of smoking/cessation.

      Conclusions

      Risks for death and hospitalization are elevated among HD patients who smoke, being highest among younger individuals and those with diabetes. Second-hand smoke was not associated with poor clinical outcomes.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dube S.R.
        • Asman K.
        • Malarcher A.
        • Carabollo R.
        Cigarette smoking among adults and trends in smoking cessation-United States, 2008.
        MMWR Morb Mortal Wkly Rep. 2009; 58: 1227-1232
        • Centers for Disease Control and Prevention
        Smoking-attributable mortality, years of potential life lost, and productivity losses–United States, 2000-2004.
        MMWR Morb Mortal Wkly Rep. 2008; 57: 1226-1228
        • Jamal A.
        • Homa D.M.
        • O’Connor E.
        • et al.
        Current cigarette smoking among adults - United States, 2005-2014.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 1233-1240
        • Collins A.J.
        • Li S.
        • Ma J.Z.
        • Herzog C.
        Cardiovascular disease in end-stage renal disease patients.
        Am J Kidney Dis. 2001; 38: S26-S29
        • Longenecker J.C.
        • Coresh J.
        • Powe N.R.
        • et al.
        Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: the CHOICE Study.
        J Am Soc Nephrol. 2002; 13: 1918-1927
        • Foley R.N.
        • Herzog C.A.
        • Collins A.J.
        Smoking and cardiovascular outcomes in dialysis patients: the United States Renal Data System Wave 2 Study.
        Kidney Int. 2003; 63: 1462-1467
        • Chang T.I.
        • Streja E.
        • Soohoo M.
        • et al.
        Association of serum triglyceride to HDL cholesterol ratio with all-cause and cardiovascular mortality in incident hemodialysis patients.
        Clin J Am Soc Nephrol. 2017; 12: 591-602
        • Shafi T.
        • Sirich T.L.
        • Meyer T.W.
        • et al.
        Results of the HEMO Study suggest that p-cresol sulfate and indoxyl sulfate are not associated with cardiovascular outcomes.
        Kidney Int. 2017; 92: 1484-1492
        • Di Lullo L.
        • Rivera R.
        • Barbera V.
        • et al.
        Sudden cardiac death and chronic kidney disease: from pathophysiology to treatment strategies.
        Int J Cardiol. 2016; 217: 16-27
        • Liebman S.E.
        • Lamontagne S.P.
        • Huang L.-S.
        • Messing S.
        • Bushinsky D.A.
        Smoking in dialysis patients: a systematic review and meta-analysis of mortality and cardiovascular morbidity.
        Am J Kidney Dis. 2011; 58: 257-265
        • Mc Causland F.R.
        • Brunelli S.M.
        • Waikar S.S.
        Association of smoking with cardiovascular and infection-related morbidity and mortality in chronic hemodialysis.
        Clin J Am Soc Nephrol. 2012; 7: 1827-1835
        • Yu P.
        • Jiao Y.
        • Reviriego-Mendoza M.
        • Larkin J.W.
        • Usvyat L.A.
        • Maddux F.W.
        Geography, life expectancy, and age of mortality in dialysis patients.
        J Am Soc Nephrol. 2016; 27 ([abstract SA-PO928]): 847A
        • Shetty K.D.
        • DeLeire T.
        • White C.
        • Bhattacharya J.
        Changes in U.S. hospitalization and mortality rates following smoking bans.
        J Policy Anal Manag. 2011; 30: 6-28
        • Kent B.D.
        • Eltayeb E.E.
        • Woodman A.
        • Mutwali A.
        • Nguyen H.T.
        • Stack A.G.
        The impact of chronic obstructive pulmonary disease and smoking on mortality and kidney transplantation in end-stage kidney disease.
        Am J Nephrol. 2012; 36: 287-295
        • Carter B.D.
        • Abnet C.C.
        • Feskanich D.
        • et al.
        Smoking and mortality — beyond established causes.
        N Engl J Med. 2015; 372: 631-640
        • National Kidney Foundation
        KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease.
        Am J Kidney Dis. 2007; 49: S12-S154
        • Sarnak M.J.
        • Levey A.S.
        • Schoolwerth A.C.
        • et al.
        Kidney disease as a risk factor for development of cardiovascular disease.
        Circulation. 2003; 108: 2154-2169
        • Fadnes L.
        • Taube A.
        How to identify information bias due to self-reporting in epidemiological research.
        Internet J Epidemiol. 2009; 7: 1-8
        • McGauran N.
        • Wieseler B.
        • Kreis J.
        • Schüler Y.-B.
        • Kölsch H.
        • Kaiser T.
        Reporting bias in medical research - a narrative review.
        Trials. 2010; 11: 37
        • Welte J.W.
        • Russell M.
        Influence of socially desirable responding in a study of stress and substance abuse.
        Alcohol Clin Exp Res. 1993; 17: 758-761
        • Raphael K.
        Recall bias: a proposal for assessment and control.
        Int J Epidemiol. 1987; 16: 167-170